Summary

Prehospital Emergency Care provides a comprehensive and student-friendly approach to EMT - Basic education. The author takes great care to provide a foundation for the skills needed to be a successful EMT - Basic. In addition, he offers clinical insight throughout the text so students have a better understanding when performing patient assessment and providing patient care. This book is ideal for the EMT-Basic who wants to go above and beyond the DOT requirements.

Table of Contents

Assessment Summaries/Emergency Care Protocols/Algorithms

xvi

Features of This Textbook

xvii

Acknowledgments

xx

Module 1 PREPARATORY

Introduction to Emergency Medical Care

1

(11)

The Emergency Medical Services System

3

(2)

A Brief History

3

(1)

Current Standards

3

(2)

The EMT-Basic

5

(7)

Roles and Responsibilities

5

(2)

Professional Attributes

7

(1)

Medical Direction

8

(1)

Quality Improvement

9

(3)

The Well-Being of the EMT-Basic

12

(17)

Emotional Aspects of Emergency Care

14

(4)

Death and Dying

14

(1)

High Stress Situations

15

(1)

Stress Management

15

(2)

Critical Incident Stress Debriefing

17

(1)

Scene Safety

18

(7)

Protecting Yourself from Disease

18

(5)

Protecting Yourself from Accidental Injury

23

(2)

Enrichment

25

(4)

Diseases of Concern

25

(4)

Medical, Legal, and Ethical Issues

29

(10)

The Scope of Practice

31

(1)

Legal Duties

31

(1)

Ethical Responsibilities

32

(1)

Issues of Patient Consent and Refusal

32

(3)

Advance Directives

32

(1)

Types of Consent

32

(2)

Refusing Treatment

34

(1)

Other Legal Aspects of Emergency Care

35

(4)

More About the Duty to Act

35

(1)

Abandonment and Negligence

35

(1)

Confidentiality

35

(1)

Special Situations

36

(3)

The Human Body

39

(31)

Anatomical Terms

40

(2)

Body Systems

42

(20)

The Musculoskeletal System

42

(9)

The Respiratory System

51

(4)

The Circulatory System

55

(4)

The Nervous System

59

(2)

The Endocrine System

61

(1)

The Skin

61

(1)

Enrichment

62

(8)

The Digestive System

62

(2)

The Urinary System

64

(1)

The Reproductive System

64

(6)

Baseline Vital Signs and History Taking

70

(13)

Baseline Vital Signs

72

(7)

Breathing (Respiration)

73

(1)

Pulse

73

(2)

Skin

75

(2)

Pupils

77

(1)

Blood Pressure

77

(2)

Vital Sign Reassessment

79

(1)

The Sample History

79

(4)

Preparing to Lift and Move Patients

83

(9)

Body Mechanics

84

(3)

Four Basic Principles

84

(1)

Posture and Fitness

85

(1)

Communications and Teamwork

86

(1)

General Guidelines for Lifting and Moving

87

(5)

The Power Lift

87

(1)

The Squat Lift

87

(2)

One-Handed Carrying Technique

89

(1)

Stair-Chair Technique

89

(1)

Reaching

89

(1)

Pushing and Pulling

90

(2)

Module 2 AIRWAY

Airway Management, Ventilation, and Oxygen Therapy

92

(36)

Respiratory System Review

94

(4)

Anatomy of the Respiratory System

94

(2)

Mechanics of Breathing

96

(1)

Respiratory Physiology

96

(1)

Airway Anatomy in Infants and Children

97

(1)

Airway Assessment

98

(8)

Opening the Mouth

98

(1)

Opening the Airway

99

(1)

Suction Equipment and Technique

100

(3)

Airway Adjuncts

103

(3)

Assessment of Breathing

106

(2)

Adequate Breathing

107

(1)

Inadequate Breathing

107

(1)

Techniques of Artificial Ventilation

108

(8)

Basic Consideration

108

(1)

Mouth-to-Mouth Ventilation

109

(1)

Mouth-to-Mask Ventilation

110

(1)

Bag-Valve-Mask Ventilation

111

(3)

Flow-Restricted, Oxygen-Powered Ventilation Device (FROPVD)

114

(1)

Automatic Transport Ventilator

115

(1)

Oxygen Delivery

116

(6)

Oxygen Cylinders

116

(1)

Safety Precautions

116

(1)

Pressure Regulators

117

(1)

Oxygen Humidifiers

117

(1)

Oxygen Administration Procedures

117

(1)

Terminating Oxygen Therapy

118

(1)

Transferring the Oxygen Source: Portable to On-Board

118

(1)

Oxygen Delivery Equipment

119

(3)

Special Considerations in Airway Management and Ventilation

122

(6)

A Patient with a Stoma or Tracheostomy Tube

122

(2)

Infants and Children

124

(1)

Patients with Facial Injuries

124

(1)

Foreign Body Airway Obstruction

124

(1)

Dental Appliances

124

(4)

Module 3 PATIENT ASSESSMENT

Scene Size-Up

128

(18)

Determine Scene Safety

129

(9)

Obtain Dispatch Information

130

(1)

Take Body Substance Isolation Precautions

130

(1)

Consider Scene Characteristics

131

(6)

Protect the patient

137

(1)

Protect Bystanders

137

(1)

Control the Scene

138

(1)

Determine the Nature of the Problem

138

(3)

Determine the Mechanism of Injury

139

(1)

Determine the Nature of the Illness

140

(1)

Determine the Number of Patients

141

(1)

Gain Scene Control and Establish Rapport

141

(5)

Achieve a Smooth Transition of Care

142

(1)

Reduce the Patient's Anxiety

142

(1)

Maintain Control

143

(3)

Patient Assessment

146

(70)

Components of the Patient Assessment: An Overview

147

(3)

Scene Size-up

150

(1)

Initial Assessment

150

(3)

Form A General Impression of the Patient

153

(2)

Determine if the Patient Is Ill or Injured

153

(1)

Obtain the Chief Complaint

154

(1)

Identify Immediate Life Threats

154

(1)

Establish In-Line Stabilization

155

(1)

Position the Patient for Assessment

155

(1)

Assess Mental Status

155

(3)

Asses the Level of Responsiveness

156

(2)

Document the Level of Responsiveness

158

(1)

Assess the Airway

158

(1)

Determine Airway Status

158

(1)

Open the Airway

158

(1)

Indications of Partial Airway Occlusion

159

(1)

Assess Breathing

159

(2)

Assess Rate and Quality of Breathing

159

(2)

Assesses Circulation

161

(3)

Assess Pulse

161

(1)

Identify Major Bleeding

162

(1)

Assess Perfusion

162

(2)

Establish Patient Priorities

164

(1)

Focused History and Physical Exam

165

(2)

Focused History and Physical Exam---Trauma Patient

167

(1)

Reevaluate the Mechanism of Injury

168

(1)

Significant Mechanisms of Injury

169

(1)

Trauma Patient with Significant Mechanism of Injury or Critical Finding

169

(15)

Continue Spinal Stabilization

169

(1)

Consider an Advanced Life Support Request

170

(1)

Reconsider the Transport Decision

170

(1)

Reassess Mental Status

170

(1)

Perform a Rapid Trauma Assessment

171

(9)

Assess Baseline Vital Signs

180

(1)

Obtain a SAMPLE History

180

(1)

Prepare the Patient for Transport

181

(1)

Provide Emergency Care

182

(1)

Trauma Score

182

(2)

Trauma Patient with No Significant Mechanism of Injury or Critical Finding

184

(1)

Perform a Focused Trauma Assessment

184

(1)

Obtain Baseline Vital Signs and SAMPLE History

184

(1)

Sometimes Perform a Rapid Trauma Assessment

185

(1)

Focused History and Physical Exam---Medical Patient

185

(1)

Unresponsive Medical Patient

186

(6)

Perform a Rapid Medical Assessment

187

(3)

Assess Baseline Vital Signs

190

(1)

Position the Patient

191

(1)

Obtain a SAMPLE History

191

(1)

Provide Emergency Care

192

(1)

Make a Transport Decision

192

(1)

Responsive Medical Patient

192

(2)

Assess Patient Complaints: OPQRST

192

(1)

Obtain a SAMPLE History

193

(1)

Perform a Focused Medical Assessment

193

(1)

Assess Baseline Vital Signs

193

(1)

Provide Emergency Care

193

(1)

Make a Transport Decision

193

(1)

Detailed Physical Exam

194

(1)

When to Perform a Detailed Physical Exam

195

(1)

How to Perform a Detailed Physical Exam

195

(12)

Perform the Detailed Physical Exam

196

(10)

Reassess Vital Signs

206

(1)

Continue Emergency Care

206

(1)

Ongoing Assessment

207

(1)

Purposes of the Ongoing Assessment

207

(2)

Detect Any Change in Condition

208

(1)

Identify Any Missed Injuries or Conditions

208

(1)

Adjust the Emergency Care

209

(1)

Repeat the Initial Assessment

209

(1)

Reassess Mental Status

209

(1)

Reassess the Airway

209

(1)

Reassess Breathing

209

(1)

Reassess Circulation

209

(1)

Reestablish Patient Priorities

210

(1)

Reassess and Record Vital Signs

210

(1)

Repeat the Focused Assessment for Other Complaints

210

(1)

Check Interventions

210

(1)

Note Trends in Patient Condition

211

(1)

Communication and Documentation

211

(5)

Assessment of Geriatric Patients

216

(19)

Effects of Aging on Body Systems

217

(3)

The Cardiovascular System

218

(1)

The Respiratory System

218

(1)

The Musculoskeletal System

218

(1)

The Neurological System

218

(1)

The Gastrointestinal System

219

(1)

The Renal System

220

(1)

The Integumentary System

220

(1)

Assessment of the Geriatric Patient

220

(5)

The Scene Size-up

220

(1)

The Initial Assessment

221

(1)

The Focused History and Physical Exam; The Detailed Physical Exam

222

(2)

Emergency Medical Care and Ongoing Assessment

224

(1)

Special Geriatric Assessment Findings

225

(10)

Assessment Finding: Chest Pain or Absence of Chest Pain

225

(1)

Assessment Finding: Shortness of Breath

226

(2)

Assessment Finding: Altered Mental Status

228

(2)

Assessment Finding: Signs of Trauma or Shock

230

(1)

Assessment Finding: Environmental Temperature Extremes

231

(1)

Assessment Finding: Geriatric Abuse

231

(4)

Communication

235

(12)

Components of an Emergency Communications System

237

(2)

Base Station

237

(1)

Mobile Transmitter/Receivers

237

(1)

Portable Transmitter/Receivers

237

(1)

Repeaters

237

(1)

Digital Equipment

238

(1)

Cellular Telephones

238

(1)

Broadcast Regulations

238

(1)

System Maintenance

239

(1)

Communicating within the System

239

(3)

Ground Rules for Radio Communication

240

(1)

Dispatch

240

(1)

Medical Personnel

241

(1)

Interpersonal Communications

242

(2)

Taking Charge

242

(1)

Communicating with the Patient

243

(1)

Special Circumstances

243

(1)

Enrichment

244

(3)

Radio Codes

244

(1)

Times

244

(1)

Radio Terms

244

(3)

Documentation

247

(11)

Reasons for Documentation

249

(1)

Medical Uses

249

(1)

Administrative Uses

249

(1)

Legal Uses

249

(1)

Educational and Research Uses

249

(1)

The Prehospital Care Report

249

(4)

PCR Formats

249

(1)

PCR Data

250

(3)

Legal Concerns

253

(2)

Confidentiality

253

(1)

Refusal of Treatment

253

(1)

Falsification

254

(1)

Special Situations

255

(3)

Multiple-Casualty Incidents

255

(1)

Special Reports

255

(3)

Module 4 MEDICAL, BEHAVIORAL, AND OBSTETRICS/ GYNECOLOGY

General Pharmacology

258

(11)

Administering Medications

259

(1)

Medications Commonly Administered by the EMT-B

260

(1)

Medications Carried on the EMS Unit

260

(1)

Medications Prescribed for the Patient

260

(1)

Medication Names

260

(1)

Routes of Administration

261

(1)

Medication Forms

262

(1)

Essential Medication Information

263

(1)

Indications

263

(1)

Contraindications

263

(1)

Dose

264

(1)

Administration

264

(1)

Actions

264

(1)

Side Effects

264

(1)

Key Steps in Administering Medication

264

(2)

Obtain an Order from Medical Direction

264

(1)

Select the Proper Medication

265

(1)

Verify the Patient's Prescription

265

(1)

Check the Expiration Date

265

(1)

Check for Discoloration or Impurities

265

(1)

Verify the Form, Route, and Dose

265

(1)

Documentation

266

(1)

Reassessment Following Administration

266

(1)

Sources of Medication Information

266

(3)

Respiratory Emergencies

269

(24)

Breathing Difficulty

271

(9)

Assessment and Care: Breathing Difficulty

271

(5)

Metered Dose Inhalers

276

(4)

Breathing Difficulty in the Infant or Child

280

(4)

Breathing Difficulty in the Infant or Child: Assessment and Care

280

(4)

Enrichment

284

(9)

Assessing Breath Sounds

284

(1)

Conditions That Cause Breathing Difficulty

284

(9)

Cardiac Emergencies

293

(19)

Circulatory System Anatomy and Physiology

295

(5)

The Heart

295

(1)

The Cardiac Conduction System

296

(1)

The Blood Vessels

297

(2)

The Blood

299

(1)

Blood Pressure

299

(1)

Inadequate Circulation

300

(1)

Cardiac Compromise

300

(3)

Assessment and Care: Cardiac Compromise

300

(1)

Nitroglycerin

301

(2)

Enrichment

303

(9)

Conditions That May Cause Cardiac Emergencies

303

(9)

Automated External Defibrillation

312

(21)

Cardiac Arrest

314

(2)

The Chain of Survival

314

(2)

Automated External Defibrillation

316

(3)

Types of Defibrillators

316

(2)

Analysis of Cardiac Rhythms

318

(1)

When and When Not to Use the AED

319

(1)

Recognizing and Treating Cardiac Arrest

319

(6)

Assessment and Care: Cardiac Arrest

319

(1)

Performing Defibrillation

320

(4)

Transporting the Cardiac Arrest Patient

324

(1)

Providing for Advanced Cardiac Life Support

325

(1)

Special Considerations for the AED

325

(4)

Safety Considerations

325

(1)

AED Maintenance

325

(1)

Training and Skills Maintenance

326

(1)

Medical Direction and the AED

326

(3)

Enrichment

329

(4)

The Electrocardiogram

329

(1)

Energy Levels of Defibrillators

330

(1)

Cardiac Pacemakers

330

(1)

Automatic Implantable Cardioverter Defibrillators

330

(3)

Altered Mental Status---Diabetic Emergencies

333

(15)

Altered Mental Status with Unknown History

335

(2)

Assessment and Care: Altered Mental Status with Unknown History

335

(1)

Conditions That May Cause an Altered Mental Status

336

(1)

Altered Mental Status with a History of Diabetes

337

(3)

Assessment and Care: Altered Mental Status with a History of Diabetes

338

(2)

Oral Glucose

340

(1)

Enrichment

340

(8)

Conditions That May Cause an Altered Mental Status in the Diabetic Patient